Partner Agency Insurance Services

What Additional Coverages Are Available Through the Affordable Care Act?

Aug 14, 2013

With the upcoming health reform changes through the Affordable Care Act (ACA) many people have questions about what kind of additional coverages will be available, and to whom?

Will the new Health Care Marketplace have Catastrophic-only coverage?

Within the Individual & Family plan offerings, there is Catastrophic-only coverage, however, it is limited to:

•  Designed for 26- to 30-year-olds only (must be available to 26–30 year-olds) and others who have an exemption from the Exchange for hardship or affordability reasons

•  Available on and off the Exchange or Marketplace

•  No benefits paid until $6,400.00 deductible is met or satisfied per individual which is integrated with Medical/Rx overall plan Deductible — with the exception of  three primary care visits and preventive services (at zero dollar cost sharing by the insured).  The total annual Out-of-pocket limit expense is $6400.00 for the Catastrophic plan.

Will Chiropractic and/or Acupuncture be offered as a benefit in the new plan designs?

No, these benefits and services are not included at this time through the Marketplace plan offerings.

Will the Marketplace offer Dental and Vision coverage?

Yes, however, the vision coverage within the medical plans is offered for children up to 19-years-old which includes an eye exam and one pair of glasses per year.

Will there be Dental coverage?

Yes, a separate or stand-alone plan will be offered at a monthly additional cost. However, at this time, the dental plan is only for children up to 19-years-old or pediatric dentistry.

Purchase of the children’s dental insurance plan is not required. However, the plans offer comprehensive child dental coverage, particularly important for consumers of child-only coverage and family plans.

The monthly dental premiums are for “stand-alone” plans which are insurance products that can be purchased by themselves to cover a specific service. Some plans will include Orthodontia benefits offered to those dependents up to age 26.

Stand-alone rates are not included for Health Net Dental, because the company is only offering children’s dental coverage bundled with its medical health insurance plans.

 

 

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